室管膜下区受累胶质母细胞瘤的MRI影像学特征及其预后分析

刘若愚; 刘明航; 攸娜; 赵悦; 伊柯帆; 赵恺; 孙国臣; 许百男

doi:10.3969/j.issn.2095-5227.2022.03.006

室管膜下区受累胶质母细胞瘤的MRI影像学特征及其预后分析

Subventricular zone contacting glioblastoma: MRI features and prognosis

摘要

摘要:
背景室管膜下区作为成年人脑内最大的神经干细胞集中部位，被认为与胶质瘤的起源密切相关。有研究指出，肿瘤与室管膜下区存在接触的胶质母细胞瘤患者具有更差的临床预后。
目的探讨存在室管膜下区受累的胶质母细胞瘤的MRI影像学表现及其对患者生存预后的影响。
方法选取2016年1月- 2018年12月于解放军总医院第一医学中心住院行手术治疗的胶质母细胞瘤患者，收集相关临床资料及影像学数据并对其进行随访，获得总生存期及无进展生存期。分析室管膜下区受累胶质母细胞瘤在影像学上有无特征性表现以及室管膜下区受累对患者生存期的影响。
结果共134例患者纳入本研究，其中男性54例，女性80例，65岁以上27例，65岁以下107例。室管膜下区受累组35例(26%)，室管膜下区未受累组99例(74%)。室管膜下区受累组患者的影像学特征表现为肿瘤内较少发生囊变(32.3% vs 51.4%，P=0.045)、肿瘤更易生长跨越中线(94.3% vs 60.6%，P＜0.001)、多灶性病变(34.3% vs 8.6%，P=0.003)、肿瘤直径更大(5.88±1.27) cm vs (3.32±1.62) cm，P＜0.001。室管膜下区受累组患者的中位总生存期(13个月vs 25个月)及无进展生存期(7个月 vs 17个月)显著低于未受累组(P均＜0.001)。多因素分析显示，室管膜下区受累是影响患者生存预后的独立危险因素(P＜0.001)。
结论室管膜下区受累的胶质母细胞瘤MRI中表现出了肿瘤内较少发生囊变、生长更易跨越中线、多灶性病变的影像学特征，且肿瘤直径更大。室管膜下区受累是影响患者总生存期及无进展生存期的独立危险因素。

Abstract:
Background As the largest concentrated region of neural stem cells in the adult brain, subventricular zone (SVZ) is considered to have a close relationship with the origin of glioma. Several studies have shown that subventricular zone involved glioblastoma at diagnosis is a negative prognosticator of patients’ survival.
Objective To study the MRI features of subventricular zone involving glioblastoma and its influence on patients’ survival.
Methods Patients with glioblastoma who underwent surgical treatment in the First Medical Center of Chinese PLA General Hospital from January 2016 to December 2018 were included. Clinical and imaging data were collected, then telephone follow-up was conducted to obtain overall survival and progression-free survival. Imaging features of SVZ involved glioblastoma and the influence of MRI subventricular zone involvement on patients’ survival were analyzed.
Results A total of 134 patients were included in this study. Among them, there were 54 males and 80 females, 27 cases were over 65 years old, and 107 cases were under 65 years old. There were 35 cases (26%) in the SVZ involved group and the other 99 cases (74%) belonged to the uninvolved group. Statistical analysis showed that the SVZ involved group appeared to have less cystic changes in the tumor (32.3% vs 51.4%, P=0.045), tumor growth crossing the midline (94.3% vs 60.6%, P＜0.001), multifocal lesions (34.3% vs 8.6%, P=0.003) and larger tumor diameter (5.88±1.27cm vs 3.32±1.62cm, P＜0.001). The median overall survival and progression-free survival were 13 months vs 25 months and 7 months vs 17 months for the SVZ involved group but and the uninvolved group (log-rank P＜0.001, respectively). In multivariate Cox survival analysis, SVZ involvement proved to be an independent risk factor for the survival of glioblastoma patients.
Conclusion The MRI features of SVZ involved glioblastomas show less intertumoral cystic transformation, easier to grow across the midline, multifocal lesions and larger tumor diameter. Besides, SVZ involvement in MRI at diagnosis is an independent negative prognostic indicator for the survival of glioblastoma patients.

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